Researchers from the University of Bristol have contributed to the Chief Medical Officer’s annual report for 2015, which focuses on women’s health with a priority of preventing and overcoming health inequality in the UK.

Professor Marianne Hester, from the School for Policy Studies, and Professor Gene Feder, from the Centre for Academic Primary Care in the School of Social and Community Medicine, authored a chapter on gender-based violence (GBV) against women, providing an overview of the health impacts of GBV for women and adolescents with focus on the current gaps in prevention and intervention with regard to sexual violence and so-called ‘honour’-based violence (HBV).

They also examined these issues in relation to vulnerable groups such as sex workers, lesbian, gay and bisexual women, women in prison or detention centres, and trafficked women.

Professor Hester said: ‘GBV against women is particularly harmful, with severe consequences for women’s physical and mental health. It violates women’s human rights, undermines their ability to participate fully in society and may take a variety of forms, including domestic violence and abuse (DVA), sexual violence, forced marriage, and female genital mutilation (FGM).

‘To overcome the health impacts of GBV, we need integrated commissioning of GBV services, and supported referrals between health services and the GBV sector that take into account the overlaps between different experiences of GBV, the specific needs of different victims/survivors, and their needs at individual, community, and system levels. Services and pathways should ensure the inclusion of marginalised groups through proactive and systematic outreach, as well as providing programmes that address the specific needs of these groups.’

The stark evidence on GBV and its impact on health covered in the report includes:

The 2013/14 Crime Survey for England and Wales (CSEW) reported that 2.2 per cent of women and 0.7 per cent of men (aged 16–59) had experienced some form of sexual assault in the past year.

The Adult Psychiatric Morbidity Survey in England 2007 estimated around 1.5 million adults, of whom 84 per cent were women, had experienced extensive physical and sexual violence, with an abuse history extending back to childhood. Over half of these adults had a common mental disorder, such as clinical depression or anxiety.

The Safeguarding Teenage Intimate Relationships survey of 4,500 young people aged 14–17 across the UK, and four other European countries, reported the highest rates of sexual coercion of teenage girls were in England, and young people were at least twice as likely to have sent a sexual image or text message if they were also experiencing violence or coercive control in their relationships.

Living in a context of ‘cultural victimisation’ associated with homophobia and hate crime may detrimentally impact lesbian and bisexual women’s health and wellbeing, and creates barriers to seeking help.

There are estimated to be 80,000 sex workers in the UK, of whom 70 per cent have a history of local authority care, and nearly half have a history of childhood sexual abuse. Eighty five to 90 per cent of sex workers are women, although the proportion is 60 to 70 per cent in central London.

The Association of Chief Police Officers has estimated that 30,000 women are involved in off-street prostitution in England and Wales.

The Home Office estimates that there are 10,000 to 13,000 potential victims of modern slavery in the UK; 55 per cent of these are female and 35 per cent of all victims are trafficked for sexual exploitation.

Between a half and two-thirds of women prisoners suffer from depression; women prisoners often have histories of domestic violence, sexual abuse and coercion.

In 2014, Women for Refugee Women published the results of a survey of 46 women who had sought asylum and had been detained; 72 per cent said that they had been raped and 41 per cent said that they had been tortured. A systematic review of asylum seekers’ experiences of violence reported greater than 30 per cent exposure to violence, but emphasised the enormous gap in good-quality, policy-relevant information on asylum, violence and health.

Professor Feder said: ‘Addressing the health impacts of GBV requires filling gaps in training of healthcare professionals, providing compassionate and non-judgemental support in hospitals and general practices, and a GBV prevention policy that integrates the health care response with other sectors – education, criminal justice, and migration.’